Client Authorized Contact Form

Billing Information:
We are excited to partner with your organization and want to make sure we have all of your billing information and authorized contacts listed appropriately.
Company Information:
Company*
Address*
City*
State*
Zip*
Billing Contact Person:
Attention to*
Title
Direct Phone*
Email*

Authorized Contacts
Next we will ask for three levels of account-level access with Digital Attic. Please place the appropriate people in each category.
Top Level: Authorized Contact Person(s)
This level of approval will give the people listed below full access to make any and all changes to your account, authorized contacts, billing, authorize work, invoicing, etc.
Top Level: Authorized Contact #1
Full Name*
Title*
Phone*
Email*
Top Level: Authorized Contact #2
Full Name
Title
Phone
Email

Support Level: Authorized Contact Person(s)
This level of authority is given to staff that can send in support requests and request work to be performed on your account.
Support Level: Authorized Contact #1
Full Name
Title
Phone
Email
Support Level: Authorized Contact #2
Full Name
Title
Phone
Email

Technical / Independent Contractor(s) Level: Authorized Contact Person(s)
We have many accounts who work with an outside company to perform technical I.T. and other services. If you work with a technology company that has the authority to make changes to your servers, domain records, etc. please list the company and contacts that have the authority to make support requests.
Company
Address
City
State
Zip
Technical: Authorized Contact #1
Full Name
Title
Phone
Email
Technical: Authorized Contact #2
Full Name
Title
Phone
Email
CAPTCHA